Introduction: Injury during peripheral nerve blocks is relatively uncommon, but potentially devastating complication. Recent studies emphasized that location of needle insertion in relationship to the fascicles may be the predominant factor that determines the risk for neurologic complications. However, it is wellestablished that concentration of local anesthetic is also associated with the risk for injury. In this study, we examined the effect of location of injection and concentration of Ropivacaine on risk for neurologic complications. Our hypothesis is that location of the injection is more prognostic for occurrence of nerve injury than the concentration of Ropivacaine.Methods: In experimental design of the study fi fty Wistar rats were used and sciatic nerves were randomized to receive: Ropivacaine or 0.9% NaCl, either intraneurally or perineurally. Pressure data during application was acquired by using a manometer and was analyzed using software package BioBench. Neurologic examination was performed thought the following seven days, there after the rats were sacrificed while sciatic nerves were extracted for histological examination.Results: Independently of tested solution intraneural injections in most of cases resulted with high injection pressure, followed by obvious neurologic defi cit and microscopic destruction of peripheral nerves. Also, low injection pressure, applied either in perineural or intraneural extrafascicular area, resulted with transitory neurologic defi cit and without destruction of the nerve normal histological structure.Conclusions: The main mechanism which leads to neurologic injury combined with peripheral nerve blockade is intrafascicular injection. Higher concentrations of Ropivacaine during intrafascicular applications magnify nerve injury.

Objective: In recent years regional anesthesia has gained great popularity. However, like any other medical procedure, the regional anesthesia carries certain risk of unintended intraneural injection and consequential neurological complications. Studies in animals have suggested that intraneural application of local anesthetics may cause mechanical injury. Previous studies, however, have used small animal models and clinically irrelevant injection speed or equipment. In this study we used equipment and injection methods in common clinical use to study the consequences and pressure dynamics of intraneural injection. Our hypothesis is that an intraneural injection is heralded by higher injection pressure and leads to neurologic impairment in pigs. Materials and Methods: Ten pigs of mixed breed (21-26 kg, 4-6 months old) were studied. After general anesthesia, the sciatic nerves (n = 20) were exposed bilaterally. Under direct vision, a 25-gauge insulated nerve block needle was placed either intraneurally (n = 10) or perineurally (n = 10), and 4 ml of preservative-free lidocaine 2% was injected using an automated infusion pump (15 ml/min). Injection pressure data were acquired using an in-line manometer coupled to a computer via an analog-to-digital conversion board. After injection, the animals were awakened and subjected to serial neurologic examinations during next 7 days. Results: All perineural injections resulted in injection pressures below 40 kPa. In contrast, intraneural injections resulted in significantly higher peak pressures (P 140 k Pa. Conclusion: High injection pressure (>140 kPa) predicts intraneural injection and consequential neurologic deficit. As long as the injection pressure is low, injection into poorly compliant tissue can be avoided and neurological complication can be prevented.

Introduction: Quality of life is a broad term that refers to the total well-being of the individual in terms of physical, psychological, emotional, mental, and social well-being, and which is in turn influenced by numerous factors including age, gender, socioeconomic status, risk factors in behavior, the environment, and the absence or presence of disease. Goal: The goal was to determine the presence of respiratory symptoms in smokers and to compare them with non-smokers as well as determine the relationship between quality of life with the frequency of respiratory symptoms from the aspect of gender, age, the environment in which they live, and the total monthly income of smokers compared to non-smokers. Material and Methods: The study was conducted on a sample of 600 subjects who were divided into two groups. The first group consisted of regular smokers (300 subjects) and the second group consisted of non-smokers. Former smokers were not included in the study. The survey questionnaire was designed on the basis of the following. A questionnaire to test the quality of life SF-36; Inventory of socioeconomic status EuroQoL; Basic respiratory symptoms were examined by MRC questionnaire (consisting of 9 questions). Results: The presence of respiratory symptoms was not associated with gender and the area of origin of the respondents, while the level of education, age, total monthly household income, and smoking status were directly related to the presence of respiratory symptoms, so that respondents with lower education levels, older ones, those with lower incomes, and smokers have more pronounced symptoms of respiratory problems. There is large negative impact of respiratory symptoms presence on respondent's quality of life. Conclusion: Smoking status were directly related to the presence of respiratory symptoms. There is large negative impact of respiratory symptoms presence on respondent's quality of life.